Full Company Name*:

Mailing Address Street:

City:

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Country:

Contact Person*:

Title:

Phone:

Fax:

Federal ID Number or Social Security Number:

Dun & Bradstreet Number:

Years in Business:

Approx. Number of Employees:

Business Size: (Choose one)
Large Business Small Business

Business Concern: (Check all that apply)

Non-Profit/Handicapped Affiliated
Government Certified SDB
Veteran Owned Small Business
Service-Disabled Veteran Owned Small Business

HubZone
Women Owned & Operated
Foreign Owned

If Small Minority Owned Business: (Check the appropriate racial group)

African American
Asian Indian
Hispanic

Native American
Asian Pacific
Other

Business Class: (Check one)

Sole Proprietorship
Corporation
Subsidiary

Partnership
Joint Venture
Other

If joint venture or subsidiary, name of parent company:

Contact at parent company:

Phone:

Principal Products / Services

Do you have a Quality Control Manual?
Yes No

Quality Control Procedures are based on:
ISO9000 Certified? Date:

By whom?

Other (Specify)

Are employees covered by a collective bargaining agreement?
Yes No

If YES, Name of Union:

Agreement Expiration Date:

Notice: In accordance with U. S. C. 645(d), any person who misrepresents a firm's proper size classification shall (1) be punished by imposition of a fine, imprisonment, or both; (2) be subject to administrative remedies; and (3) be ineligible for participation in programs conducted under the authority of the Small Business Act.

Name*:

Title:

Date*:

Email*:

Comments:

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